Vertebral denervation in conjunction with vertebral fusion

Abstract

Described herein are various implementations of systems and methods for treating back pain (e.g., chronic low back pain) caused by different (e.g., independent) sources of pain, such as pain originating or stemming from intervertebral discs, from vertebral endplates, and/or from intraosseous locations within one or more vertebral bodies. For examples, methods for treating back pain (e.g., chronic low back pain) may involve both vertebral fusion (e.g., arthrodesis or spondylodesis to fuse adjacent vertebrae) and neuromodulation (for example, ablation of nerves within or surrounding one or more of the adjacent vertebrae). The neuromodulation may facilitate treatment of pain that is generated by insertion of fusion hardware.

We claim: 
     
         1 . A method of treating multiple independent sources of low back pain of a patient during a single therapeutic intervention, the method comprising:
 performing a spinal fusion procedure between two adjacent vertebrae of the patient, including leaving one or more hardware components within or surrounding each of the adjacent vertebrae;   inserting an access tool within a cancellous bone region of a vertebral body of one of the two adjacent vertebrae, the access tool comprising a lumen extending therethrough to facilitate access to the cancellous bone region;   inserting a neuromodulation device through the lumen of the access tool until at least a distal end of the neuromodulation device extends beyond the access tool within the cancellous bone region;   modulating a basivertebral nerve within the cancellous bone region using the neuromodulation device; and   removing the neuromodulation device and the access tool from the patient.   
     
     
         2 . The method of  claim 1 , wherein the step of inserting the access tool within the cancellous bone region comprises extrapedicularly inserting the access tool within the cancellous bone region using an access location superior to a pedicle of a superior vertebra of the adjacent vertebrae. 
     
     
         3 . The method of  claim 1 , wherein the step of inserting the access tool within the cancellous bone region comprises extrapedicularly inserting the access tool within the cancellous bone region using an access location inferior to a pedicle of an inferior vertebra of the adjacent vertebrae. 
     
     
         4 . The method of  claim 1 , further comprising identifying the two adjacent vertebrae by determining that the two adjacent vertebrae exhibit one or more Modic changes. 
     
     
         5 . The method of  claim 1 , wherein the two adjacent vertebrae comprise an L5 vertebra and an S1 vertebra. 
     
     
         6 . The method of  claim 1 , wherein the two adjacent vertebrae comprise lumbar vertebrae. 
     
     
         7 . The method of  claim 1 , further comprising inserting the access tool within a cancellous bone region of a vertebral body of the other one of the two adjacent vertebrae while avoiding contact with the one or more hardware components and inserting the neuromodulation device through the lumen of the access tool until at least a distal end of the neuromodulation device extends beyond the access tool within the cancellous bone region of the vertebral body of the other one of the two adjacent vertebrae. 
     
     
         8 . The method of  claim 1 , wherein the neuromodulation device is configured to deliver radiofrequency energy sufficient to ablate the basivertebral nerve. 
     
     
         9 . The method of  claim 1 , wherein modulating the basivertebral nerve comprises ablating the basivertebral nerve with ultrasound energy. 
     
     
         10 . A method of treating multiple independent sources of low back pain of a patient having two adjacent vertebrae in a lumbar or lumbosacral region, each vertebra comprising a vertebral body with a cortical bone region and a cancellous bone region containing intraosseous nerves, during a single therapeutic intervention, the method comprising:
 performing a spinal fusion procedure between the two adjacent vertebrae of the patient, including leaving one or more hardware components within or surrounding the adjacent vertebrae;   inserting an access tool through the cortical bone region into the cancellous bone region of a vertebral body of one of the two adjacent vertebrae while avoiding contact with the one or more hardware components, the access tool comprising a lumen extending therethrough to facilitate access to the cancellous bone region;   inserting a neuromodulation device through the lumen of the access tool until at least a distal end of the neuromodulation device extends beyond the access tool and into the cancellous bone region; and   modulating an intraosseous nerve within the cancellous bone region using the neuromodulation device.   
     
     
         11 . The method of  claim 10 , wherein inserting the access tool within the cancellous bone region comprises extrapedicularly inserting the access tool within the cancellous bone region using an access location superior to a pedicle of a superior vertebra of the adjacent vertebrae. 
     
     
         12 . The method of  claim 10 , wherein inserting the access tool within the cancellous bone region comprises extrapedicularly inserting the access tool within the cancellous bone region using an access location inferior to a pedicle of an inferior vertebra of the adjacent vertebrae. 
     
     
         13 . The method of  claim 10 , further comprising identifying the two adjacent vertebrae by determining that the two adjacent vertebrae exhibit one or more Modic changes. 
     
     
         14 . The method of  claim 10 , wherein the two adjacent vertebrae comprise an L5 vertebra and an S1 vertebra. 
     
     
         15 . The method of  claim 14 , wherein the two adjacent vertebrae comprise lumbar vertebrae. 
     
     
         16 . The method of  claim 11 , further comprising inserting the access tool within a cancellous bone region of a vertebral body of the other one of the two adjacent vertebrae while avoiding contact with the one or more hardware components and inserting the neuromodulation device through the lumen of the access tool until at least a distal end of the neuromodulation device extends beyond the access tool and into the cancellous bone region of the vertebral body of the other one of the two adjacent vertebrae. 
     
     
         17 . The method of  claim 10 , wherein the neuromodulation device is configured to deliver radiofrequency energy sufficient to ablate the intraosseous nerve. 
     
     
         18 . The method of  claim 17 , wherein modulating the intraosseous nerve comprises ablating the intraosseous nerve. 
     
     
         19 . The method of  claim 10 , wherein the intraosseous nerve is a basivertebral nerve.